or Crossed Eyes
Strabismus is a misalignment of the eyes. It includes in-turned eyes, called Esotropia, out-turned eyes, called Exotropia and other eye muscle disorders. Sometimes children are successfully treated for strabismus only to redevelop strabismus later in life. This may be secondary to the inability of a person to use both eyes together, called binocular vision, or other unknown causes. People who have one eye that does not see well when fully corrected with glasses, called Amblyopia, may develop strabismus with time. Most often, the poorer seeing eye drifts outward. In adults who suddenly develop strabismus we must be concerned about vascular insults to a nerve that controls the movement of one or more eye muscles. This is most often seen in adults with a history of diabetes or high blood pressure.
Types of Strabismus
This form of esotropia, or crossed eyes is also known as infantile esotropia. It usually develops before the child is six months old and is characterized by a large eye turn. Unlike Accommodative esotropia, glasses will not correct the eye turn. Amblyopia is common in children with congenital esotropia and should be treated early. Once the child’s vision is equalized, treatment can be recommended for the eye turn. Eye muscle surgery is the treatment for patients with infantile esotropia. The surgery is usually performed on both eyes, although it may also be done on one eye. The goal of treatment in infantile esotropia is to straighten the eyes so that the child can learn to use them together and develop “binocular vision. The ability to use both eyes together will help to keep them aligned. Studies have shown that early surgical alignment improves the chances of developing binocular vision. Therefore, many pediatric ophthalmologists recommend surgery when the angle of crossing is stable and the vision in each eye is good.
Many children with congenital esotropia develop other eye muscle disorders. This occurs even when their eyes have been successfully made straight with surgery. Recurrent esotropia following surgery for congenital esotropia occurs frequently and often can be treated with glasses and not require further surgery. This is a different type of esotropia than the original infantile crossing. Many patients develop vertical strabismus which can occur months to years after the original surgery. Treatment may require further surgery.
As you can see, infantile esotropia is a complex disorder. Although surgery is required to treat it, it is only the start of the process. These children must be carefully followed for other problems during the visually immature period of their life.